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FOR OFFICE USE: o f' ---�---- APPLICATION FOR SANITATION PERMIT Permit No. -A__l__Lk,k, C ( om lpe to in Duplicate) y -- ----- ---- - This Permit Expires.1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described"Z ,,..., This application is made in compliance with County Ordinance No. 549. -Viv4 JOB ADDRESS AND LOCATION____.. .___.!_ ---------- ---�--`----- --G. -l- -44" -- -:--...---'.._._.._._. ----- - ---------- Owner's Name_-__ t' 1?,�-.. ,�o. ------ Phone--___ __--- _�. _J Address-------------------- ------ --•--- Contractor's Namer .�[ "' "" ___ 1_� a/, Y' ____ .�°L.�-__ Phone" - ______ Q_ - : - - --- .010 Installation will serve: 'Residence ❑ Apartment House ❑ Commercial ❑ Tr, ' Court ❑ Motel ❑ Other ❑ Number of living units: _��unify er of bedrooms ____,Number of baths 1-------Lot size Water Supply: Publics stems stem Private De th to Water Table eft.PP Y� Y Y ❑ ❑ p ; w Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ _Clay Loam ❑, .Clay ❑ Adobe . ardpan ❑ f Previous Application Made: fIf yes,date---_-__--____-__ -1 No ❑ New Construction: Yes ❑ No 1HA/VA: Yes ❑ :No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I {No septic tank-or cesspool permitted if public sewer is available within 200 feet.}- / C. Septic Tank: Distance from nearest well_t4�_Distanc from found ion____/Q_7-_- Material__PA---_ -' ___ter__ No- of com arfinents-- _ rr�� Size-_-- u�d de th 1,$'�--/-_Ca aci# l- -s2-____-- � p F�-•• . - �- G I? - p Y-- Up , 4 .�r osai.Field: Distance from nearest weil_N��.-Distance from foundation----�O__ ____Distance to nearest lot line-.__{-�___..... Length of each line___ - 0-,0------__--__.Width of trench___ _4�_,��________________ a i Number of I'snes___•-_l--- ------------- --- g � E Type.of,filter,materia Depth of filter material____:_- _ Total len th_f----------------- _�_____- ' Seepage Pit: Distance to nearest well_..- -_-__-Distance' om`fourn'dation=�_P_-.__.Dista ceoto nearest lot lin --_. --J Number of pits_-____�_____________Lining material:- aSize: Diameter---.5-�-_-.----.Depth_-4-_.7______--_--_______ _- Cesspool: Distance from nearest well-----------------Distance from ou--nd- aficnl--.-__-------_-.Lining material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth= Liquid Capacity----------------------------gals. 1 Privy Distance from nearest well_________ ________--. Distance from nearest building ________________________ __________ Distance to nearest lot line--�-- i, x" ; --------------------------------------` - ------- -- - --- --- --- - -----*� ❑ '. s Remodelin and/or repairing describe ____________--------------------__ yam_ "�: «�.._ 9 � P 9 � �= - .fig---��--�------ -----. a.---`-�-•1--- -• -- p _ _____ ________ ________________ ___________-._"-_-_--- _ _____ ______ _____ ________ ____________._ ______ _ _____.____. _ + pry - ` 1 - ---t ._ _-•-- f ----------------------- --------•--------------------------------------------- — — ---------------------------------------------------- 4 I hereby certify that I haves prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an&Tul s and'regulations of the San Joa uin Local alth District. 3 « r(Signed)ALI� - -- -- ----t- --- -------- Contractor] 8� .,�.�.,,...,. ---------------------------------------........................ "'�F` -- - {rtle} (Plot plan, showing size of.]*t, location of system in rel on to wells, buildi s, etc., can be placed on reverse side]. + # - FORD PARTMENTI-USE ONLY APPLICATION ACCEPTED BY---- - fdc�c DATE - �'' REVIEWED BY-------------- ----- ---------•- DATE------------ f BUILDINGPERMIT ISSUED---------------------'"------------------------ ----------------------=------------- DATE--------------- --------------------------- •--- Alte ns a or rec mendations:----:" --- - - - ------- Z- -------•---- __ 1 -- --------- --- - ----�- ----` -= -------------------- --------------------------------- --------- { , l ------------------------ -- ---- --------------------------------------------------------------------------------- -------------------------------------------- FINAL INSPECTION BY:-- - - -- --- Date - --- - - - L?----------------------------------- JOAQUIN LOCAL HEALTH,-DISTRICT 1601 E.Harellon Ave. I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California _; ES 9 REVISEd 8.59 3M 3-'63 F.P.CO.